Multisite Spinal Cord and Canal Morphometry Reveals Age-Linked and Sex-Linked Structural Vulnerability in Degenerative Cervical Myelopathy Outcomes

BACKGROUND AND OBJECTIVE: Degenerative cervical myelopathy (DCM) is the most common cause of nontraumatic spinal cord (SC) dysfunction in adults, yet early predictors of disease severity, progression, and recovery are unclear. The influence of age and sex on morphometric SC and canal changes is also unknown. We evaluated whether SC and canal morphology associate with age, sex, clinical severity, and surgical outcomes in DCM. METHODS: A retrospective cohort of 160 participants was enrolled across 4 institutions: 100 patients with DCM and 60 healthy controls (HCs). All underwent T2-weighted cervical MRI. We used our upgraded, fully automated pipeline to extract morphometrics, including cross-sectional area (CSA), anterior-posterior (AP) and right-left (RL) diameters, eccentricity, solidity, and canal compromise [via the adapted spinal canal occupation ratio (aSCOR)]. The modified Japanese Orthopaedic Association (mJOA) was used to measure neurological function at baseline and at the 6-month follow-up. Random forest regression identified demographic and morphometric predictors of surgical outcome. RESULTS: HC females exhibited smaller CSA, RL diameters, aSCOR than HC males (P < .05), whereas males with DCM showed significantly lower CSA, AP diameter and higher eccentricity, and aSCOR at C3-C4 (P < .005) than their female counterparts. A reduction in SC size and alterations in SC shape correlated with increasing age in both DCM and HC males, but not in females. The aSCOR score was elevated in DCM vs HCs at C3-C7 (P < .05). Surgical patients had higher baseline compression [reduced CSA, AP, RL, (P < .05)] and showed greater mJOA improvement at follow-up than nonsurgical patients [ΔmJOA (mean ± SD): 2.4 ± 1.3 vs 0.9 ± 1.0; P = .003]. Overall, 50.6% of the variance in mJOA outcomes was explained by CSA, aSCOR, and RL diameter. CONCLUSION: Automated SC morphometry reveals key age-dependent and sex-dependent differences in DCM. Age-based and sex-based morphometrics offer anatomically specific and individualized biomarkers for risk stratification, progression monitoring, and surgical outcome prediction.